Revenue Cycle Specialist

Summit Pacific Medical Center•Elma, WA

1d•$28 - $41•Onsite

About The Position

The Revenue Cycle Specialist is responsible for supporting the integrity and system framework supporting Revenue Cycle. Partners closely with the Billing, and Health Information Management/Coding teams, and department leaders to ensure compliance in claims administration. Develops reporting, dashboards and KPIs, providing seamless, accurate measurements used to enhance operational performance across Summit. Assists in the education of our patients regarding health insurance including explaining services covered by specific plans, as well as assisting the enrollment process in Washington Apple Health (Medicaid and Qualified Health Plans.

Requirements

Graduate of an accredited school with a minimum of an associate degree.
Washington Health Benefit Exchange In-Person Assister Certification is required at the time of hire and/or within 90 days of accepting the position.
Comprehensive knowledge of the patient access/registration, coding, chargemaster, charging and billing work environments, workflows, and tasks.
Knowledge of medical terminology.
Intermediate to advanced skills in statistical modeling, data mining, analysis, and reporting.
Knowledge of financial and benchmarking standards and related best practices.
Proficient in the use of current technology, including Microsoft Office products.
Ability to learn and effectively use electronic medical records and other systems and equipment.
Ability to develop and maintain proficiency with insurance verification processes via multiple online and telephone insurance registry systems.
Strong problem-solving and organization skills; ability to effectively prioritize work.
Professional and effective written and verbal communication skills.
Ability to identify and employ communication strategies appropriate to the audience.
Strong mathematics skills and knowledge of payment processing functions.
Ability to work collaboratively and effectively with multiple demands and sort time frames.
Ability to work independently performing a wide variety of assignments that require the use of independent judgment, problem-solving, organization, and prioritization skills.

Nice To Haves

Bachelor’s degree in Math, Statistics, Biostatistics, Public Health, Finance, Accounting or closely related field is preferred.
Three (3) years of healthcare revenue cycle, data analysis and reporting experience preferred.

Responsibilities

Provides direct support to the revenue cycle department to ensure revenue capture integrity.
Researches, plans, and implements revenue cycle projects to maximize the cash flow/revenue returns to the medical center.
Assists in managing workflows and processes to support revenue, patient throughput, patient experience, and regulatory requirements.
Performs moderately complex data queries, mapping and analysis functions to ensure efficient and optimal utilization of Epic revenue cycle modules.
Performs audits of accounts and productivity reporting to ensure department operational procedures are being implemented.
Designs and develops data extractions, analysis, and reporting tools/dashboards for operations, to ensure financial objectives of value-based care contracts are met.
Maintains an accurate Chargemaster, while identifying problems with charge capture and implementing reliable solutions for improvement; continually identifying opportunities to automate processes and improve revenue capture.
Acts as a resource for internal and external customers and delivers exceptional service.
Participates in process improvements and problem solving; researches and analyzes alternatives for improving work flows. Develops “best practice” recommendations.
Maintains the insurance and provider NPI master files integrity and makes any necessary updates and/or changes.
Responds to patient inquiries and requests.
Ensures the patient’s comfort, dignity, safety and confidentiality at all times.
Works as a liaison between our billing office, revenue cycle and all other departments.
Ensures resolution of claims; develops internal processes improvements to ensure timely submission of claims.
Supports enrollment, charity care, and other discount application processes.
Actively assists patients and community members with enrollment in Washington Apple Health (Medicaid) and/or Qualified Health Plans.
Processes admissions, performs verification of benefits/authorization, notification to the payor; including clinical information sent to payor as needed to obtain authorization for admission. The analysis includes, but not limited to review of patient’s demographics, payor data review, understanding payor methodology, commercial vs. government payor structures. Working knowledge of and understanding of diagnosis and patient’s prognosis, reviewing medical records as necessary to determine clinical information needed for payor.
Performs other duties and special projects as assigned.
Adapts to changes in the work environment: Asks clarifying questions and/or provides constructive input in a helpful and respectful manner.
Builds and maintains working relationships: Maintains effective working relationships with supervisor and direct co-workers.
Creates positive experiences for patients, customers and, co-workers: Consistently provides a level of service that meets SPMC standards.
Demonstrates ongoing learning & development: Participates in ongoing skills training and competency development.
Exhibits effective work skills: Successfully performs job duties in accordance with SPMC expectations for quality/accuracy, quantity, and timeliness. Re-priorities and/or shifts focus as needed to deliver expected results.
Facilitates Teamwork: Actively engages in team activities. Welcomes and supports new team members; promotes a positive work environment.
Fosters an environment of trust: Treats others with courtesy and respect. Does not engage in gossip or triangulation.
Supports SPMC mission, vision, and values: Develops awareness of departmental contribution to mission, vision and strategy. Participates in department strategies and tactics.

Benefits

Competitive Compensation
Medical
Prescription
Dental (including Orthodontia)
Vision
Healthcare FSA and daycare FSA
Daycare subsidized benefit
Life Insurance
Accidental Death and Dismemberment (AD&D)
Short- and long-term disability
Generous employer 403b match contributions for retirement
457 retirement account for additional funds
Employee Assistance Program (EAP)
Tuition reimbursement
Smoking Cessation Assistance
Employee Wellness Program
Employee Committees to participate in such as Spirit Team
Beautiful on-site gym for employees
Instructor led fitness classes for employees, including Yoga, Kettlebells and Bootcamps
Walking trails on site